| NPI | 1215944590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 1116) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 1367) |
| 363A00000X Physician Assistant (Licence: RI PA00350) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-08-25 |